A traumatic event, miscarriage is the loss of the fetus before the 20th week of pregnancy, but most often in the first trimester. Pain and bleeding may alert the pregnant woman to the occurrence of a miscarriage, which by definition implies the cessation of fetal cardiac activity. We observe miscarriages in around 25% of all early pregnancies, and recurrent pregnancy losses in 5% of cases. Recurrent pregnancy loss (RPL) is defined as 2 consecutive miscarriages or more before the age of 40. From this point onwards, further investigations are necessary.
Despite advances in research, 50% of recurrent pregnancy loss remain unexplained. Reproductive immunology enables us to find explanations and personalized solutions for women who suffer repeated miscarriages.
Psychological care for women and couples is absolutely essential, as every miscarriage is a painful event, and support is fundamental.
Genetic, hormonal, autoimmune or uterine abnormalities for recurrent miscarriages
The causes are many and varied. Recurrent pregnancy loss can be the result of chromosomal abnormalities in the mother or father (rare event) or embryo. Genetic abnormalities of the embryo may account for up to 50% of miscarriages. However, the more pregnancy loss a woman has, the less likely it is that a genetic error will be the cause. Certain sperm abnormalities can also increase the risk of miscarriage.
Blood tests for the couple’s karyotype can be carried to identify a balanced translocation in one or other of the partners.or a caryotype abnormality (1%)
Maternal age is an important factor in causing genetic abnormalities in the embryo, as the number of abnormal oocytes (aneuploidy) increases dramatically after the age of 38.
Endocrine abnormalities are also responsible for premature fetal loss. Hormonal imbalances can affect the progress of pregnancy, particularly in cases of thyroid disorders, hyperprolactinemia or ovarian insufficiency.
Other causes include polycystic ovary syndrome (PCOS), low ovarian reserve, coagulation disorders or autoimmune problems such as antiphospholipid syndrome or lupus.
It is also important to check the integrity of the uterine anatomy for polyps or uterine fibroids, or problems of thin endometrium.
The impact of the pregnant woman’s environment must also be taken into account: diet, stress, age, and exposure to certain substances. Research is advancing to better understand the impact of these factors.
The promise of reproductive immunology for personalized treatment
Dr. Nathalie Lédée and her teams have been studying immunology for many years, in an attempt to better understand unexplained recurrent pregnancy loss (still the vast majority of cases). The idea is to gain a better understanding of the uterine environment by establishing an endometrial immune profile, in order to propose personalized treatments.
This profile, produced using the PCT/EP2013/065355 test designed and patented by MatriceLab, enables us to gain a better understanding of unexplained RPL, and to propose treatments to help the next pregnancy run smoothly.
By measuring precise biomarkers using an RT-PCR test performed on an endometrial biopsy taken during a consultation, the mechanism of RPL may be identified (insufficient embryo nutrition ? immune rejection reaction?). MatriceLab finds a cause in 75% of so-called unexplained RPL, and can thus propose therapeutic options to optimize the success rate of the next attempt.
A study dedicated to women who had suffered of RPL showed that identifying uterine dysregulation and tailoring treatment accordingly multiplied live birth rate by a factor of 3 in the 6 months following diagnosis.
“We made the choice to do the test after several miscarriages where the heart stopped, several failures and the death of our daughter due to intrauterine fetal demise.
Unsurprisingly, I was over-activated, which reassured me because I felt there was a problem. We resumed ART and today our rainbow baby was born on Christmas Day. <3 “
Cindy C.
This diagnostic test, which establishes the endometrial immune profile, is promising for understanding the cause of 75% of previously unexplained RPL. The personalized recommendations provided thanks to the identification of the immunological mechanism give new hope to couples who are currently at a loss, powerless in the face of the impossibility of explaining and therefore understanding and moving forward.